tbuckley/cabot-search huggingface dataset:
PS13 Meeting the care needs of transgender patients in dermatology
Authors: Sarah O’Mahony, Anne Marie Tobin
Journal: British Journal of Dermatology (2023)

Abstract Transgender persons are a diverse group whose gender identity differs from the sex recorded at birth. Some, but not all, choose to undergo medical treatment to align their physical appearance with their gender identity. It is important that clinicians understand the specific medical issues relevant to this population. Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety and depression, in addition to their own individual healthcare needs. It is important that staff in the healthcare setting are prepared to care for this population, to ensure the best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. Improving the quality of care will reduce health disparities commonly faced by the transgender population. In our department, we have encountered difficulty in maintaining accurate gender identity data. We describe a case of a transgender woman attending the outpatient dermatology services for treatment of hidradenitis suppurativa and acne vulgaris. In addition to management of their dermatological conditions, there are issues with mislabelling in their chart. This includes the use of outdated labels and the inability to update their current forename from their original forename under their medical record number and on the patient information system. Electronic health records (EHRs) are the cornerstone in managing accurate patient information in hospitals. Healthcare institutions should have the capacity to collect accurate and up-to-date gender identity data, and gender-related demographic fields. However, the utility of gender identity fields in retrospectively identifying transgender patients, which is important for clinical care, as well as population health management, remains unknown. Clinic operations, EHRs, clinic culture, clinic environment, resource availability and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatological care for transgender patients. In addition to basic demographic details, transgender individuals may face unique dermatological needs. Exogenous hormones affect hair and sebum production. Hormonal therapy leads to drastic skin alterations, impacting on sebum production, hair growth and acne, all of which may become a dermatological concern for transgender patients. Dermatologists have the opportunity to not only improve transgender patient care, but also their experience of healthcare. It is imperative that EHRs can provide accurate gender identity data and correct name use to close the gap in inequality in transgender population healthcare.
BT10 Skin lesion triage teledermatology service: a review of secondary care 2-week wait upgrades
Authors: Clare Harnett, Bethany Mitchell, Richard Azurdia, Stephanie Gallard, Paul McGovern
Journal: British Journal of Dermatology (2023)

Abstract A teledermatology service for skin lesions was commenced in January 2021 initially as a pilot scheme with six general practices and one dermatology department in a metropolitan area; to date, 70% of the city practices have since been on-boarded. Many 2-week wait (2WW) referrals are made not just for suspected skin cancer, but also for cases where there is diagnostic uncertainty and secondary care opinion/reassurance sought. The aim of the service was to embed a fully integrated information technology solution to facilitate single skin lesion triage in an attempt to help to address the 2WW capacity issues in secondary care. The referring general practitioners (GPs) were provided with a mobile phone adaptor attachment and dermatoscope to obtain images of the index lesion in question. A proforma that includes a concise history of the lesion and clinical impression is completed. The GPs were encouraged to use this triage service but could also refer directly to the 2WW service if concerned. The consultant then provided advice and guidance with a menu of triage outcomes, including upgrade to a 2WW appointment. We reviewed the referrals received via this skin lesion pathway and numbers of cases converted to a 2WW appointment from 12 April to 1 December 2022 as a snapshot of the service. We aimed to determine factors from the referral that prompted the conversion. There were 1201 skin lesion referrals, and 299 cases were converted to 2WW (24.9% of the cohort). In 93 of 299 referrals, the GP’s impression was possible squamous cell carcinoma or melanoma. In 137 of 299 cases, the GP had not provided a clinical impression. In 70 of 299 referrals, the GP’s clinical impression correlated with the dermatology’s impression based on the dermatoscopic images. In 44 cases, the clinician’s impression based on the image was of a benign lesion; however, we noted that a more cautious approach was adopted by some clinicians who triaged to 2WW if there was any diagnostic uncertainty. After face-to-face review, 159 of 299 were listed for biopsy or excision. Some factors identified that limited diagnostic accuracy included poor image quality and some referrals contained multiple lesions, causing confusion. This skin lesion triage service appears to support the idea that photographic triage could reduce the burden of 2WW face-to-face referrals. Areas for improvement identified include ensuring that the referrer provides a concise history and clinical impression, the use of gel for dermatoscopic images and feedback when images are not of adequate quality. In the future, it may be necessary to consider photographic hubs to standardize referral photographic quality.
PD05 Investigating the course of atopic eczema up to 1 year following completion of narrowband ultraviolet B phototherapy
Authors: Dimple Jain, Sonali Bajaj, Prachi Desai, Shyamal Wahie
Journal: British Journal of Dermatology (2023)

Abstract Narrowband UVB (NBUVB) is a recommended second-line treatment for moderate-to-severe atopic eczema unresponsive to adequate topical therapy, and is known to induce good short-term improvement of eczema severity (Reynolds NJ, Franklin V, Gray JC et al. NBUVB and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001; 357:2012–16). However, it is unclear how adult patients fare with their eczema severity long after completion of a course of NBUVB. We aimed to investigate the severity of atopic eczema in adults, 1 year following the completion of NBUVB, using validated clinical activity measures. We hypothesized that, after 1 year, eczema severity would remain better than at baseline (prior to having NBUVB). We undertook a multicentre prospective observational study of adults with atopic eczema (as per Hanifin and Rajka criteria) prescribed NBUVB as part of their standard clinical care. Participants had moderate-to-severe disease, with a minimum objective SCORAD of 15 and minimum Investigator’s Global Assessment (IGA) of 3, and were resistant to at least one conventional treatment (e.g. potent topical steroid). Eczema severity was assessed by selected investigators using SCORAD and IGA. Assessments were made at baseline, at the end of NBUVB and at 4, 8 and 12 months after completion of NBUVB. We aimed to recruit 80 patients at the outset to provide us with about 25–30 patients for analysis at the 1 year post-NBUVB follow-up. Eighty patients (47 men, 33 women) with a mean age of 37 years (range 18–83) were recruited, with a baseline mean (SD) SCORAD of 39.2 (12.5). Forty-nine patients could not attend to complete NBUVB or the follow-up visits thereafter. Three patients had to stop NBUVB as their eczema flared. Mean baseline SCORAD of the 28 patients who completed the study was 41.3 (14.7), with the mean IGA being 3 (range 3–4; reflecting moderate to severe disease, respectively). Compared with baseline, mean SCORAD was significantly lower at the end of NBUVB [19.1 (13); P &amp;lt; 0.001] and at 4 months post-NBUVB [21.9 (11.9); P &amp;lt; 0.001]. Furthermore, compared with baseline, there was a sustained ongoing reduction of mean SCORAD at 8 months [22.6 (13.1); P &amp;lt; 0.001] and 12 months post-NBUVB [21.1 (14.8); P &amp;lt; 0.001]. Mean SCORAD at 1 year was not statistically significantly different to that on completion of NBUVB (P &amp;gt; 0.5). Change in IGA matched similar sustained improvement trends with SCORAD. These findings indicate that NBUVB may provide a long-lasting effect for patients who complete a course, helping to diminish their eczema severity to a more manageable level. These data can further inform consultations with patients, when outlining the approach of NBUVB for their care.
DS13 A comparative study between recipient site preparation using manual dermabrasion and tattooing pen in autologous noncultured epidermal cell suspension procedure in stable vitiligo patients: a randomized double blinded study
Authors: Akshay Meena, Davinder Parsad, M Sendhil Kumaran, K Vinay
Journal: British Journal of Dermatology (2023)

Abstract Vitiligo is a common acquired disorder of depigmentation that occurs as a result of melanocyte loss. Surgical therapies are indicated in patients with stable disease who fail to respond to medical therapies. This mostly includes autologous grafting techniques both tissue and cellular (both cultured and noncultured). Common techniques of recipient site preparation include dermabrasion, suction blistering, liquid nitrogen, electrofulguration and microneedling. The aim was to assess the difference in extent of repigmentation with manual dermabrasion and tattooing pen in a noncultured epidermal cell suspension on stable vitiligo patches. This was a prospective intraindividual comparative study. Thirty-six patients with stable vitiligo were recruited. Patients had a clinical diagnosis of segmental or nonsegmental vitiligo and had two independent patches of 3 × 3 cm or more present either symmetrically or unilaterally over the same body site or a single patch of 6 × 6 cm or more. Vitiligo lesions had been stable for ≥ 1 year. At week 24, the proportion of patients achieving &amp;gt; 75% repigmentation with manual dermabrasion was 86%. In contrast, 61% of patients in the tattooing pen group achieved &amp;gt; 75% repigmentation. At week 24, the proportion of patients achieving &amp;gt; 50% repigmentation with manual dermabrasion was 89% vs. 72% of patients in the tattooing pen group. Eighty per cent of patches at acral sites in patients in the manual dermabrasion group achieved &amp;gt; 75% repigmentation vs. 94% in nonacral patches, whereas in the tattooing pen group, 47% of patches at acral sites achieved &amp;gt; 75% repigmentation vs. 73.3% in nonacral patches. In terms of colour matching, at 24 weeks, good colour matching with the surrounding normal skin was obtained in 80% of patches in both groups. There was a significant difference in efficacy between the two methods in favour of manual dermabrasion. Tattooing pen for melanocyte delivery has the advantage over manual dermabrasion in that it is less time consuming and also reduces cell loss. Recipient site preparation by manual dermabrasion showed a higher rate of infection vs. the tattooing pen at 4 weeks (25% vs. 6%). Recipient site preparation in terms of colour matching and halo phenomena was comparable in both the groups, with no significant difference seen. Patient satisfaction in terms of physician global assessment score and Vitiligo Quality of Life index (VitiQoL) was comparable for both methods, with no significant difference seen.
PD08 Sun protection practices of men in the west of Ireland
Authors: Jason Hynes, Laoise Griffin, Mary Laing
Journal: British Journal of Dermatology (2023)

Abstract Irish men get more skin cancer than women, especially of the head and neck area. They typically get more sun exposure and are less likely to wear sun protection factor (SPF). Little is known about the types of hats men wear, or photoprotective practices regarding the lips. We carried out an observational study, using a questionnaire, on men aged &amp;gt; 18 years attending dermatology for any reason. Fitzpatrick skin type and Norwood classification for male pattern baldness was documented. Sixty-one men [mean (SD) age 56 (16.9) years] were involved. Forty-nine per cent were attending for the assessment of skin lesions. Thirty-eight per cent were on immunosuppression. Sixty-four per cent worked outdoors currently or in the past, 79% have or had spent &amp;gt; 3 h outdoors daily. Twenty-six per cent had a Norwood classification of ≥ 3v (vertex of scalp showing). The majority (71%) was of Fitzpatrick skin types I and II. Seventy-nine per cent wore SPF, 19% daily and 17% during the summer. Only 15% of men reported wearing lip SPF. Sixty-eight per cent reported wearing a hat on a ‘sunny day’. Of these, 54% wear baseball (BB) caps, 20% wear a wide-brimmed hat (WBH), 20% a narrow-brimmed hat, 4% a wool or traditional cap and 2% a total face covering. Age did not influence whether a hat was worn, but it did influence the type, with younger men more likely to wear BB caps and older men more likely to wear WBH. Those with hair thinning were more likely to wear a hat (87% vs. 67%). Non-hat-wearers were also less likely to wear SPF. Despite the incidence of skin cancer in sun-exposed sites in men, few studies have focused on photoprotective practices of the head and neck. Our study demonstrates that while Irish men wear SPF, few wear SPF on their lips. Additionally, Irish men often wear a hat type that would not be considered to provide adequate photoprotection to the head and neck. Hat type varied with age, with younger patients wearing less photoprotective hats. When considering photoprotection campaigns, factors such as age, fashion trends and education regarding lip SPF should be considered.
GD08 Migrant dermatology
Authors: Marta Costa Blasco, Anne Marie Tobin
Journal: British Journal of Dermatology (2023)

Abstract Conflict, war or economic hardship often causes refugees to flee their communities. The recognition of refugees as a diversified group from a medical aspect is one of importance as they have a range of health needs that differ from the native population. Based on a review of the published literature and cases we have reviewed in our dermatology department, we would like to outline an overview of the challenges associated with managing skin conditions for migrants and refugees, as well as key opportunities to improve care for this community. The initial barrier experienced is primarily related to communication difficulties. Healthcare providers meet obstacles in trying to communicate effectively with refugees as translation services are not always readily available and the waiting time involved for such services results in a further delay in patient management. It came to our attention that refugees often do not communicate all their issues or symptoms because of other complex social issues that take precedence over their symptoms. A separate, substantial issue arises given the lack of documentation regarding their medical background and previous and current treatments. Other challenges faced are the costs associated with accessing pharmaceutical products and not having primary care physicians. Furthermore, staying in temporary accommodation makes it more likely that they will not receive follow-up appointments, resulting in future missed appointments. Overall, refugees are a vulnerable cohort and a substantial multidepartment effort should be made to ease their integration into national healthcare ­systems.
H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)
Authors: James Ralph
Journal: British Journal of Dermatology (2023)

Abstract Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.
DP18 Extraocular sebaceous carcinoma <i>in situ</i>
Authors: Rona Applewaite, Anthony Abdullah
Journal: British Journal of Dermatology (2023)

Abstract Extraocular sebaceous carcinoma in situ (SCIS) is exceedingly rare with &amp;lt; 10 cases reported in the literature (Jeong KM, Seo JY, Kim A et al. Extraocular sebaceous carcinoma in situ concurrent with actinic keratosis: a case report and review of the literature. Korean J Dermatol 2021; 59:307–9). An 80-year-old man reported a 3-month history of a right forehead lesion that had been bleeding. This was a subtle 5 × 5 mm papule on clinical examination, and dermoscopy showed arborizing telangiectasia. Past medical history was significant for 20 basal cell carcinomas, one squamous cell carcinoma, Bowen disease and actinic keratoses. Histology showed sun-damaged skin with a partially eroded neoplasm of lobular architecture, with surface and infundibular epithelium containing atypical sebocytes and squamous cells with no infiltrative growth pattern, which was consistent with SCIS and was fully excised. Immunohistochemistry revealed patchy adipophilin and androgen receptor staining and stronger epithelial membrane antigen staining. Furthermore, there was preserved expression of MSH2, MSH6, MLH1 and PMS2. Sebaceous carcinoma in situ is a debated entity not formally recognized in the classification of sebaceous neoplasms. Kazakov et al. reported five cases of dermal sebaceous tumours with ‘benign’ architectural features (well-circumscribed and no evidence of invasion) but with cytological atypia (abnormal mitoses and pleomorphism) (Kazakov D, Kutzner H, Spagnolo DV et al. What is extraocular cutaneous sebaceous carcinoma in situ? Am J Dermatopathol 2010; 32:857–8). The authors questioned whether these cases represented sebaceous adenomas with atypia or sebaceous carcinomas (Kazakov et al.). In response, it has been argued that such architectural–cytological discordant tumours can be regarded as SCIS owing to the fact that, by definition, carcinoma in situ is a cancer that remains wholly at the site of origin. However, it is argued that these lesions have an unclear origin and may not arise from sebaceous glands in the skin, unlike the more common aggressive periorbital sebaceous carcinomas that arise from meibomian glands and glands of Zeis (Kazakov et al.). It has been postulated that a SCIS diagnosis should be reserved for intraepidermal tumours not extending beyond the epidermal basement membrane, which is a vanishing minority of sebaceous neoplasms (Kazakov et al.). Similar to our case, a 2021 case report identified SCIS without any connection to an adnexal component but concurrent with actinic keratosis. These authors proposed that the tumour cells of intraepidermal squamous neoplasia can differentiate towards malignant sebocytes (Jeong et al.). Although controversial, SCIS appears to have reasonable, clear histological criteria for diagnosis and an excellent prognosis, with no reports of recurrence following surgical excision. We feel it is important to increase identification to avoid the overtreatment of such lesions.
BT13 MySkinDoctor: lessons learnt from assessing 120 000 teledermatology patients
Authors: Bav Shergill
Journal: British Journal of Dermatology (2023)

Abstract MySkinDoctor is a novel teledermatology platform that enables dermatologists to review images submitted directly by the patient via their smartphone, in addition to any metadata and the standard general practitioner referral. The three sets of data are used to triage or provide advice and guidance to National Health Service patients throughout the south east of England. Since its inception in 2019, the service has completed the assessment of &amp;gt; 120 000 cases. Analysis of the data shows that an unnecessary first appointment has been avoided in 48% of cases. This has led to a sharp reduction in waiting times in the areas in which it is being used (an average of 6 weeks) vs. neighbouring areas where waiting times remain between 27 and 50 weeks. Another benefit of the service is that, on average, each patient using it submits three digital images that are subsequently tagged inter alia with their age, sex, body location and the consultant’s diagnosis. This has resulted in a large, and growing, digital image library with associated dataset of patients that has been used to develop an artificial intelligence platform called ‘dermXai’. Using convolutional neural networks for image identification has produced an accuracy of determination of &amp;gt; 90% for the top 20 conditions seen. We will discuss the implementation schedule and regulatory challenges that need to be met in order for dermXai to support clinical decision-making. There are also environmental and economic benefits associated with using MySkinDoctor. Since its inception, it has saved &amp;gt; 40 000 road miles—over twice Earth’s circumference. This is a CO2 saving of 16 488 kg. The benefit to patients and their carers in terms of saving travel and regaining otherwise lost productivity time is difficult to quantify but could be studied prospectively. Patient-led digital dermatology is the obvious evolution of traditional teledermatology and our successful experience with MySkinDoctor and dermXai in southern England provides a template for a national service that will eliminate backlogs and significantly reduce patient waiting times. Conflicts of interest: Dr Bav Shergill is the Chief Medical Officer of MySkinDoctor Ltd and a Director of dermXai.